Vitamin D3 Treatment in Pediatric Systemic Lupus Erythematosus

This is an interventional treatment trial for Systemic Lupus Erythematosus focused on measuring SLE, Vitamin D3, Vitamin D deficiency, IFN alpha expression Read More

Inclusion Criteria:

• Written informed consent signed by the subject or parent/guardian as appropriate; child assent as appropriate;
• Before the age of 19, met at least 4 of the 11 modified American College of Rheumatology (ACR) 1982 Revised Criteria for the Classification of Systemic Lupus Erythematosus as updated in 1997;
• Date of SLE diagnosis (as described in Inclusion Criterion 2) at least 24 weeks prior to randomization;
• Serum 25-hydroxyvitamin D [25(OH)D] < 20 ng/mL at Screening;
• SELENA SLEDAI score > 0 and < 8 at Screening and at Baseline;
• If taking prednisone (or equivalent corticosteroid), the dose must be ≤ 15 mg/day or ≤0.5 mg/kg/day, whichever is lower, and stable for at least four weeks prior to randomization. Note, if subjects are taking steroids every other day, divide their dose by 2 to evaluate eligibility;

• Stable immunosuppressive dose for at least 12 weeks prior to randomization;

  --Immunosuppressive medications allowed include mycophenolate (MMF), azathioprine, methotrexate, antimalarial medications (e.g., hydroxychloroquine), cyclosporine A (CsA), tacrolimus, intravenous immune globulin (IVIG), and abatacept.

• Body weight > 25 kg;
• Able to swallow pills;
• Males and females with reproductive potential must agree to practice effective measures of birth control.

Exclusion Criteria:

• Any condition or treatment that, in the opinion of the investigator, places the subject at an unacceptable risk as a participant in the trial;
• Current pharmacologic vitamin D2 or D3 intake > 800 IU daily or use of calcitriol at any dose over the past four weeks prior to randomization;
• Cyclophosphamide or IV glucocorticoid exposure within 12 weeks prior to randomization;
• Any BILAG A or B manifestation with the exception of a BILAG B mucocutaneous manifestation at screening, and excluding the renal BILAG criteria (see rituximab or belimumab criterion, below);

• Significant renal insufficiency defined as:

  • Estimated GFR < 60 mL/min/1.73m^2 or estimated GFR < 90 mL/min/1.73m^2 with a reduction of the GFR by > 15% from the last measurement;
  • Urine dipstick value of 2+ or higher for protein, unless this is a stable value from the last measurement or, urine protein-creatinine ratio ≥ 50 mg/mmol unless the value represents an improvement of ≥ 25% from the last measurement.
• Rituximab or belimumab exposure use within 24 weeks prior to randomization;

• The following laboratory parameters at the Screening visit:

  • Platelets < 50,000; WBC < 2,500; ANC < 1,000;
  • Hemoglobin < 9 mg/dL;
  • ALT, AST, bilirubin > 2x upper limit of normal (ULN);
  • Hypercalcemia (calcium > ULN);
  • Hypercalciuria (urinary calcium/creatinine ratio > 0.2).
• Primary hyperparathyroidism (known);
• History of nephrolithiasis (known);
• Diabetes mellitus requiring insulin therapy;
• Medications that interfere with vitamin D absorption;
• History of vertebral compression fractures (known);
• Pregnancy (girls ≥ 11 years of age must have a negative urine/serum pregnancy test);
• A history of non-adherence/non-compliance;
• Other investigational drug and/or treatment during the four weeks or seven half-lives of the other investigational drug prior to the start of study product dosing (Day 0), whichever is the greater length of time to enrollment;
• Current diagnosis of cancer or chronic infection such as Hepatitis B, Hepatitis C, or tuberculosis;
• Treatment with digoxin;
• Flu (influenza) vaccination within one week prior to randomization.